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Provider Digest | Volume 221

Date: 06/17/26

Register Today: Doula Listening Session

Trillium Community Health Plan invites doulas to join representatives from the Oregon Doula Association and Trillium for a Doula Listening Session. You'll share your experiences, build relationships, strengthen mutual understanding, and explore ways we can partner to support pregnant and postpartum individuals in our community. 

Agenda items include an overview of Trillium staff roles and the doula contracting process, Start Smart for Your Baby® program overview and member incentives, and time for networking and group discussions.

  • Tuesday, June 30, 2026, 11:00 a.m.–1:00 p.m.
  • Trillium Community Health Plan, 400 International Way, Suite 150, Springfield, OR 97408 
  • On-site free parking in front of the building or in the lot on the west side of the building
  • Light refreshments will be served 
  • View agenda and register for the Trillium Doula Listening Session

We hope you’ll join us as we collaborate to support families in our community.

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Effective August 1, 2026: Trillium & Wellcare Billing/Coding Edits

Trillium and Wellcare are committed to continuously improving our claims review and payment processes. Effective August 1, 2026, we will begin applying national CPT billing guidelines for the appropriate coding of outpatient emergency department Evaluation and Management (E&M) code levels. 

Both Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have documented that E&M services are among the most likely services to be incorrectly coded, resulting in improper payments to practitioners. The OIG has also recommended that payers continue to help to educate practitioners on coding and documentation for E&M services and develop programs to review E&M services billed for by high-coding practitioners.  

Overview of Trillium Health Plan E&M Program

  • Applies the relevant E&M policy and recoding of the claim line to the corrected E&M level of service
  • Allows reimbursement at the highest E&M service code level for which the criteria is satisfied based on our comparative peer risk adjustment process

According to the Federal Registrar and American College of Emergency Physicians, the level of service for the emergency department (ED) Evaluation and Management (E/M) codes is based primarily on the resources utilized by the facility and staff of the ED. Facility resources include, but are not limited to, nursing time, clinical staff effort, supplies, equipment, and overhead directly related to the patient’s care, as distinct from the physician’s cognitive work. Professional E/M codes for providers are reported to capture the clinical complexity and intensity of the work performed by the provider; however, E/M codes for facilities are reported for the amount and intensity of resources utilized by the facility to provide the care of the patient. 

Policy Number: CC.PP.80
Policy Name: Leveling of Care: Emergency Department Evaluation and Management Overcoding for Facility Services
Line of Business Impacted: Medicare, Medicaid
EX Codes: AMISYS: EXLc

Thank you for your continued participation and cooperation in our ongoing efforts to render the highest quality healthcare to our members.

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Monthly Trillium Provider Orientation Sessions: Choose the Date that Works Best for You

Please join our Provider Engagement team for a hosted virtual orientation session for all new contracted providers and currently contracted providers who would like updates for 2026.

All sessions will contain the same content and will cover the following topics important to providers, including:

  • Trillium website – tips and tour of resources  
  • Introduction to provider portals      
  • Credentialing     
  • Claims submission     
  • Prior authorization check tool   
  • Interpreter services     
  • Family planning and women’s healthcare services   
  • Population Health case management services      
  • Behavioral Health services    
  • Free clinical trainings      
  • Access and availability provider appointment standards     
  • How to connect with your dedicated Provider Engagement Account Manager 

Note: If you need accommodations or would like to schedule an individual session for your team/provider group, please contact ORProviderExperience@TrilliumCHP.com.

We look forward to connecting with you!

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